AMAB ch 33 AH

psychogenic causes erectile dysfunction

(in the mind: performance anxiety, depression)

organic cause ED

(physical: vascular disease, diabetes, nerve damage, surgical trauma)

workup for ED

exual and medical history, full symptom analysis, targeted physical exaM

tx organic ED

PDE-5 inhibitors . If pills fail: vacuum erection devices or surgically implanted penile prostheses.

ejaculation before or just after penetration, with no feeling of voluntary control, causing distress

premature ejacualtion

meds for premature ejaculation

SSRIs, some TCAs, topical local anesthetics, tramadol, PDE-5 inhibitors, and alpha-adrenergic blockers.

behavioral therapy, partner-involved therapy

cannot ejaculate even with a good erection and stimulatio

Inhibited ejaculation:

main causes Inhibited ejaculation:

neurological disorders, previous surgery (especially radical prostatectomy), and drug side effects.

Why prostatectomy affects sex:

the surgery happens right next to delicate nerve and blood-vessel bundles on the back of the prostate. If they get cut or stretched, the nerves can't signal blood vessels to relax (erections suffer) and ejaculation control suffers.

Inflammation of the prostate, acute or chronic

Prostatitis

acute cause Prostatitis

bacterial infection,

culture and sensitivity testing shows E. coli is the most common

prostate gland tissue grows bigger (non-cancerous) and squeezes the urethra, so urine has a hard time getting out of the bladder

BPH (benign prostatic hyperplasia)

what to do mild causes BPH (benign prostatic hyperplasia)

WATCHFUL WAITING

meds for BPH (benign prostatic hyperplasia)

: alpha-adrenergic blockers (relax prostate smooth muscle) and 5-alpha-reductase inhibitors (shrink prostate volume).

surgery if keep progressing

Scope (resectoscope) goes up the urethra and cuts out the blocking inner prostate tissue

TURP (transurethral resection of prostate)

main risk TURP (transurethral resection of prostate)

hemorrhage; needs continuous bladder irrigation (CBI); clots can block the catheter

moderate invasive

implants pull tissue out of the way

UroLift

steam (thermal vapor) destroys tissue

rezum

how invasive UroLift / Rezum

Low (minimally invasive)

urolift/rezum what to know

Brief painful urination (dysuria), local discomfort, lower risk of fluid shifts or major bleeding

what to know about Green Light Laser / HoLEP

Less bleeding than TURP; little heat damage to nearby tissue

moderate invasive

Prostate tissue removed through an abdominal incision

Open prostatectomy

what to know about open prostatectomy

Higher bleeding risk, severe pain, wound infection, long recovery

high invasive

symptom early prostate cancer

rarely causes symptoms

screening for prostate cancer

uses a digital rectal exam (DRE) plus a blood test called PSA (prostate-specific antigen)

risk factor prostate cancer

older age, family history of prostate cancer, inherited gene mutations (like BRCA1, or family history of breast/ovarian cancer), abnormal DRE, high baseline PSA. Smoking history and some job exposures also raise risk.

After TURP the patient has a three-way indwelling catheter. runs in constantly

and flushes blood and clots out so the catheter doesn't clog (clot retention).

•

Sterile fluid (irrigant)

How to titrate the flow: TURP

adjust the irrigation speed to keep urine light pink or clear. If it turns bright red or

has heavy clots, speed the irrigation UP.

• Bladder spasms around the catheter for TURP mean

clot retention or the bladder muscle contracting uncontrollably (uninhibited detrusor contractions). Treat with antispasmodics.

True urine output: for TURP the drainage bag holds urine PLUS the irrigation fluid.

Total bag output minus irrigant volume

: 6 hours after TURP, CBI is running. Suddenly nothing drains into the bag, and the patient has severe lower belly fullness and sharp pain. what could this mean

can be blood clot

immediately turn OFF the CBI (otherwise fluid keeps filling the bladder with no way out) and manually irrigate the catheter with sterile normal saline as ordered to reopen it.

(inflammation of epididymis)

epididymitis

(inflammation of the testes)

infectious or non-infectious causes.

orchitis

tx orchitis

antibiotics, elevation, and supportive care

a collection of fluid in the sac around the testis (tunica vaginalis)

hydrocele

abnormally dilated veins (pampiniform venous plexus) in the scrotum. Feels like a 'bag of worms.'

variocele

• Most common solid cancer in young men; very treatable and curable if found early.

testicular cancer

symtomps testicular cancer

(slow and sneaky): a firm, painless lump; painless testicle enlargement; feeling of heaviness in the scrotum or groin; dull backache (from lymph nodes behind the abdomen, retroperitoneal); lower belly pain; weight loss; general weakness.

NOT a sign of testicular cancer

Painless hematuria

tx testicular cancer

radical inguinal orchiectomy (surgical removal of the testis), radiation, chemotherapy. Before treatment, counsel about sperm banking.

the foreskin is too tight to pull back over the glans (head of penis

Phimosis

Phimosis tx

circumcision

a painful erection lasting hours that has nothing to do with sexual desire. This is a true urologic emergency.

Priapism

Priapism tx

corporal aspiration and irrigation with diluted alpha-adrenergic agents or anticoagulants , or a surgical shunt, to prevent permanent tissue scarring (ischemic fibrosis) and erectile impotence.

quiet, painless and slow, so people wait too long to get checked. \

testicualr cancer

loud, extremely painful and urgent.

low-flow blood is trapped in the penis, tissue is starved of oxygen, pressure builds, and cells die quickly. If you wait, scar tissue forms and the patient becomes permanently impoten

Priapism